Cognitive Behavioral Therapy for Dental Phobia

A recent study conducted in Germany added to a growing body of research that supports the use of cognitive behavioral therapy (CBT) for dental phobia. This study compared four different groups of patients, grappling with dental phobia, including groups with: 1) CBT treatment; 2) individualized hypnosis, administered by a trained dentist; 3) standard hypnosis, induced by listening to a CD; and 4) general anesthesia. Unlike previous literature on the subject of dental phobia, observations in this study were taken before and after initial treatment, and during preparation for a second treatment. The CBT intervention, consisting of two sessions, included psychoeducation, practicing relaxation techniques, as well as identifying dysfunctional thoughts and replacing them with adaptive thoughts. Measures were taken to rate overall anxiety, dental anxiety, cognition related to dental work, feeling of control related to dental work, state-trait, and subjective rating of treatment effectiveness. Their findings showed CBT was the most effective treatment in terms of acceptability and effectiveness. The authors noted one of the study’s limitations was that it was not a randomized control trial. The authors also noted that since CBT was administered before the patient entered the dental chair, and hypnosis did not begin till after this anxiety inducing event had already occurred, it may have had an effect on the results, and should be investigated.

Wannemueller, A., Joehren, P., Haug, S., Hatting, M., Elsesser, K., & Sartory, G. (2011). A practice-based comparison of brief cognitive behavioral treatment, two kinds of hypnosis and general anesthesia in deal phobia. Psychotherapy and Psychosomatics, 80:159-165. doi:10.1159/000320977

Cognitive Behavior Therapy of Anxiety for Terminal Cancer Patients

Patients suffering from terminal cancer are often plagued by anxiety over disease progression, pain, decreased functioning, and death. Cognitive Behavior Therapy (CBT) interventions for anxiety are designed to help clients test the reality and functionality of undue worrying. Geer, Park, Prigerson, and Safren (2010) indicate that excessive anxiety may lead to treatment non-adherence, and further diminish quality of life for these patients. The authors propose tailoring CBT to better serve this population.

Three case studies of patients, with incurable lung cancer, were presented in this article.  The patients showed decreased anxiety, improvement in quality of life, ability to manage stress more effectively, and improved communication with family and friends. The authors concluded, “Our tailored treatment approach helped patient gain a sense of personal control and improve quality of life in the face of an uncertain future and unpredictable disease course;” they also added that further research for treating this population of patients with CBT is needed.

The CBT treatment, described by these authors, for terminal cancer patients with anxiety was divided into four modules: “1) psychoeducation and goal setting; 2) relaxation training; 3) coping with cancer fears; and 4) activity planning and pacing.”  Treatment was aimed towards helping patients learn coping skills that reduce anxiety, as well as develop skills in managing symptoms of cancer and the side effects of chemotherapy. This protocol recommends a total of 6 to 7 intensive sessions.

Geer, J.A., Park E.R., Prigerson,H.G., and Safren, S.A. (2010). Tailoring cognitive-behavioral therapy to treat anxiety comorbid with advanced cancer. Journal of Cognitive Psychotherapy. 1; 24(4): 294-313. doi:10.1891/0889-8391.24.4.294.

The basis for Cognitive Therapy as described by Aaron T. Beck, M.D.

My present notion of cognitive therapy is that it is based on a theory of psychopathology (information processing model), and the techniques that are utilized are those that can help to ameliorate the dysfunctional aspects of the individual’s beliefs, interpretations, and avoidance behaviors, as well as dysfunction in attention and memory. Thus, in a given case, at a given time, the therapist might choose to focus on the beliefs, misinterpretations, safety behaviors, selective focus or selective attentional inhibitions, aberrations in memory, or defects in executive function. The selections of interventions will vary according to what seems to be most feasible for a given patient, and also, the therapist’s particular skills. Basically, the therapeutic armamentarium that is available will be utilized selectively. In general, however, the main thrust of the therapy will be to modify the dysfunctional cognitive processing.